药物流产结局的临床超声评价

发布时间：2018-03-26 19:36

本文选题：临床　切入点：评价　出处：《泰山医学院》2013年硕士论文

【摘要】：目的药流结局的临床评价，多数用超声。本文探讨彩色多普勒血流成像（以下简称CDFI）的血流信号监测在决定是否需行清宫术时的临床意义。方法 2012年1月至2013年2月在我院确诊为宫内早孕且采用米非司酮配伍米索前列醇行药物流产的患者，将其中复查彩超显示子宫宫腔内有略高回声或不均质回声者148例。根据彩超的CDFI提示，将回声区探及血流信号的86例作为有血流信号组（A组），余下的未探及异常血流信号的62例作为无血流信号组（B组）。将A组患者按其是否立即清宫分为两个亚组，其中66例即刻清宫者为组1，未即刻清宫且要求继续服用药物者20例为组2，将B组患者按其是否继续用药分为两个亚组，其中49例继续用药者为组3，拒绝用药且即刻清宫者13例为组4，所有用药患者均于用药5天后复查彩超并进一步处理。所有清宫者的标本联系病理科送检。结果 A组86例彩超示宫内回声区探及血流信号者中，组1为66例，均清宫并标本送病理示查见绒毛和蜕膜组织，拒绝清宫且要求服药者即组2共20例，其中16例用药后复查彩超一至数次仍提示宫内异常回声，最后行清宫术，病理结果亦示查见绒毛组织和蜕膜组织，仅4例用药后宫内残留组织自行排出，复查彩超结果正常。B组彩超示宫内回声区未探及血流信号的62例患者中，组3服药者49例再次或数次复查彩超，最后46例超声结果正常。仅3例清宫，，病理示蜕膜组织及血块，组4即刻清宫者13例，病理结果显示蜕膜组织和/或凝血块11例，仅2例病理结果亦示查见绒毛组织。A组患者的清宫率（95.35%）和B组患者的清宫率（25.81%）差异有显著性（P＜0.05）。结论药物流产后宫腔内不均质回声团块需手术清宫抑或药物促其排出，彩超CDFI血流信号提示具有重要的监测意义，对临床医师进一步的治疗有很大的指导意义。其对于不需清宫仅需进一步用药即可使宫内残留的蜕膜或血块排出体外的患者来说，避免了手术创伤和继发不孕等并发症发生。
[Abstract]:Purpose. In the clinical evaluation of the outcome of drug flow, ultrasound is mostly used. This paper discusses the clinical significance of color Doppler flow imaging (CDFI) in determining whether or not to clear the uterus. Method. From January 2012 to February 2013, patients with early intrauterine pregnancy and misoprostol with mifepristone and misoprostol were diagnosed in our hospital. There were 148 cases with hyperechoic or nonechoic echo in uterine cavity. According to the CDFI indication of color Doppler ultrasound, 86 cases of echo region detecting blood flow signal were treated as group A with blood flow signal, and the remaining 62 cases of undetected and abnormal blood flow signal were treated as group B. Group A patients were divided into two subgroups according to whether they immediately cleared the uterus. Among them, 66 cases were treated as group 1 and 20 cases as group 2. Group B patients were divided into two subgroups according to whether they continued to take the medicine or not. Among them, 49 patients continued to use drugs as group 3, 13 patients refused medication and 13 patients immediately cleared the uterus as group 4. All the patients were examined by color Doppler ultrasound after 5 days of medication and further processed. All the specimens of the patients were submitted to pathology department for examination. Results. In group A, there were 66 cases in group 1 of 86 cases whose echo area was detected by color ultrasound, and 20 cases in group 2 who refused to clear uterus and asked for medication, all of them were clear of uterus and sent to pathology to detect villus and decidua tissue, and 20 cases were refused to clear uterus and asked to take medicine. Among them, 16 cases were examined by color Doppler ultrasound for one to several times to indicate abnormal echo in uterus. Finally, uterine clearance was performed. The pathological results also showed that villi and decidua tissues were found, and only 4 cases had left the residual tissues in the uterus by themselves. In group B, there were 49 cases who took medicine in group 3, 49 cases had repeated or repeated reexamination of ultrasound, only 3 cases were clear uterus, pathology showed decidua tissue and blood clot, the results of color Doppler ultrasound were normal in group B, and the echo area of intrauterine echo was not detected in group B, and 49 patients in group 3 took medicine again or several times, and the results of ultrasound were normal in the last 46 cases. There were 13 cases of immediate uterine clearance in group 4, 11 cases of decidua tissue and / or clot, and only 2 cases of chorionic villus tissue. Only 2 cases showed that there was a significant difference between group B and group B (P < 0.05), and the rate of clear uterus in group A was 95.35% (P < 0.05), and that in group B was 25.81% (P < 0.05). Conclusion. The uneven echo mass in uterine cavity after medical abortion should be removed by surgery or drugs. Color Doppler ultrasound (CDFI) is of great significance in monitoring blood flow signal. It is of great significance for clinicians to further treatment. It can avoid complications such as surgical trauma and secondary infertility for patients who do not need to clear the uterus and only need further medication to discharge the residual decidua or blood clot out of the body.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R169.42

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